Healthcare Provider Details

I. General information

NPI: 1417220401
Provider Name (Legal Business Name): BUFFY STILES RT(R), RDMS, RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 16TH ST W STE 21
BILLINGS MT
59102-4100
US

IV. Provider business mailing address

PO BOX 22093
BILLINGS MT
59104-2093
US

V. Phone/Fax

Practice location:
  • Phone: 406-969-4340
  • Fax: 406-969-4341
Mailing address:
  • Phone: 406-860-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number33757
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: